VP, Claims Operations
About The Position
We are seeking a strategic and hands-on Vice President, Claims Operations to join our specialty property and casualty insurance claims leadership team. This executive will strengthen claims operating discipline by building key performance indicator driven reporting, defining claims analytics requirements, and leading internal and third-party administrator file review/quality assurance programs. The Vice President will translate operational insight into meaningful process improvement, stronger vendor accountability, and scalable claims excellence - improving consistency, compliance, reserving discipline, and overall claim outcomes.
Requirements
- 10+ years of progressive claims experience, preferably within an insurer overseeing TPAs in Property & Casualty lines.
- Bachelor's degree required.
- Strong knowledge of claims processes, regulatory compliance, and industry best practices.
- Deep understanding of claims life cycle, reserving practices, LAE drivers, and claims financial metrics.
- Experience defining analytical requirements for claims-related reports, KPIs and metrics to drive operational performance.
- Experience designing and conducting TPA or claims file reviews, or quality assurance assessments across internal claim teams and/or TPAs.
- Strong analytical skills with the ability to translate data into operational and financial strategy.
- Excellent negotiation, communication, and executive presentation skills.
- Proficiency in claims management systems and data reporting tools.
Nice To Haves
- Experience with Specialty lines of business is a plus.
Responsibilities
- Drive claims operations performance by governing and benchmarking TPAs, strengthening vendor accountability, and translating analytics into clear operational and financial strategy.
- Build and lead KPI-driven reporting by defining analytical requirements and tracking claims KPIs, dashboards, and metrics to measure effectiveness and drive continuous improvement.
- Partner with TPAs on corrective actions to address performance gaps, emerging trends, and control issues.
- Establish a formal TPA governance and Quality Assurance program - scorecards, performance reviews, operating cadence/escalations, and standardized file review criteria, scoring, and reporting - to ensure consistent claims quality.
- Conduct regular operational reviews with TPAs to evaluate results against service expectations, contractual standards, KPIs, and claim-handling requirements.
- Lead internal and TPA claims file reviews to assess handling quality and discipline, including coverage analysis, investigations, reserving, documentation, litigation and vendor management, and compliance with company standards.
Benefits
- Full Suite of Medical Benefits
- Long Term Financial Incentives – STOCK!
- 401k with 3.5% Automatic Fully Vested Employer Contributions
- Competitive PTO + Holiday Program
- Lifestyle Spending Allowance
- Professional Development Assistance
- Career Exploration Opportunities
- Regular company-wide social events (even virtually!)
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What This Job Offers
Job Type
Full-time
Career Level
Executive
